NURS 6050 Global Healthcare Comparison Matrix And Narrative Statement

NURS 6050 Global Healthcare Comparison Matrix and Narrative Statement

Global Healthcare Issue	Social Determinates of Health (SDH)The Commission on Social Determinants of Health was established by the World Health Organization (WHO) in 2005. The Commission was entrusted with locating evidence-based initiatives and tactics that advance health equity and generate support for taking concrete steps to achieve it. The Commission was dissolved when the report was given to WHO in 2008, since its’ directive had been fulfilled. The Commission delivered three recommendations for the global community to consider when addressing social determinates of health. They are, improve daily living conditions; tackle the inequitable distributions of power, money, and resources; and measure and understand the problem and assess the impact of action (WHO, 2021 NURS 6050 Global Healthcare Comparison Matrix and Narrative Statement).
Description	To address inequity in health and healthcare delivery, countries worldwide are beginning to recognize and address the social determinates of health (SDH). Social determinates of health are conditions and environments in which people are born, live, work, play, worship, and age, that affect a wide range of health, functioning, and quality-of-life outcomes and risks (Healthy People 2020, 2020). The World Health Organization (WHO) works to develop and align measures for a global approach to address SDH, along with countries like the United States and Canada. National leaders and policy makers are recognizing that inequity in social determinates directly impact the health and quality of health care its citizens receives. Some examples of SDH include, safe and affordable housing, accessible food markets, access to quality employment opportunities, access to emerging technologies, quality education, and quality health care. More examples include residential segregation, discrimination, racism, their exposure to crime, and violence. By establishing policies that positively impact social and economic conditions, we can ensure improved health for large numbers people that will be sustained for longer periods of time.
Country	United States	Canada
Describe the policyin each country	The social determinates of health initiative is lead by Healthy People 2020. The goal is to create social	Canada is considered one the healthiest countries worldwide. Its’ government was one of the first to

related to the identified healthcare issue

and physical environments that promote good health for all. The Healthy People 2020 has divided the SDH into 5 primary categories: economic stability, education, health and healthcare, neighborhood and built environment, and social and community context (Healthy People 2020, 2020).

adopt policies and develop strategies to address SDH when WHO launched the initiative in 2005; they recognize the root of health inequities are social. Canada has committed to improving social causes of illness through the creation of the Canadian Reference Group on Social Determinates of Health.

This group will focus on expanding the knowledge base related to Intersectoral action, work, and Aboriginal People’s health; increasing awareness and support of public decision makers; and contributing to systemic change (WHO, 2021).

What are the strengths of this policy?

This policy has strength in numbers; the widespread support from the CDC and other organizations within the federal government, like National Institute of Health, Health and Human Services, and Medicare and Medicaid, collaborate to programs to back the policy. One program the CDC has developed is the Health Impact in 5 years (HI-5) Initiative. HI-5 is composed of a short list of evidence-based community health programs and interventions aimed to assist states improve its health outcomes. Some interventions are expanding transportation system, expanding early childhood education programs, and making loans and grants available for home improvements. The CDC set up the SDH web portal, which allows users to find SDH resources on one website (CDC, n.d.).

Under the Rio Political Declaration on Social Determinates of Health, Canada has documented its’ actions to address SDH. They have formed numerous programs and dedicated multiple resources and tools to its’ cause. Canada has convened the Canadian Council on Social Determinates of Health, a collaborative, multi-sectoral group solely dedicated to addressing the social factors that impact health and wellbeing (Government of Canada, 2020).

What are theweaknesses of this policy?

Even though recognition and support to address SDH is rapidly growing, organizations have failed to break from their individual action plans and partner

Waldron, 2010 reports racialised, immigrant, and refugee groups continue to be negatively impacted by social factors. Structural and institutional inequality is

	with each other to make more progress. Currently the health care systems, public health departments, and social services departments all work toward improving the populations SDH, but they have done so with distinct and separate missions. These entities have to agree upon common principles and strategies to guide their efforts toward addressing social determinate of health (Green & Zook, 2019).	embedded in Canada’s processes and practices, these factors must be eliminated before Canadians can feel the effects of changes made to improve SDH. Failure to recognize and address the historically biased systems inhibits success of any steps taken to combat SDH.
Explain how the social determinants of health may impact the specified global health issue. (Be specific and provide examples)	The World Health Organization Global Commission on the Social Determinates of Health determined that social injustice is killing populations on a grand scale (Donkin et al., 2018). The SDH impacts the life expectancy of populations, for example in Baltimore City, MD and Washington, D.C., those living in poor areas have a life expectancy 20 years shorter than people who live in more affluent areas in the same city.	The social determinates of health is a major culprit in health globally. Research shows that SDH doesn’t only impact poor countries, it impacts wealthy countries as well. A country’s status is defined by how healthy its’ citizens are, unfortunately there are large numbers of Canadians are affected by social determinates of health. SDH is recognized as a top priority, nationally and globally, with each country striving to reduce its impact on its people, ultimately increasing healthy populations worldwide.
How has each country’s government addressed cost, quality, and access to the selected global health issue?	According to the CMS Office of the Actuary, national health spending is projected to grow rapidly and reach $6.2 trillion by 2028. For its part, in 1985, Medicaid spending consumed less than 10% of state budgets and totaled just over $33 billion dollars. In 2019 that number had grown to consume 29% of total state spending at a total cost of $604 billion dollars (CMS, 2021).CMS has changed its’ payment model from a fee-for-service to value-based, meaning clinicians will now be held accountable for their patients’ health	In its’ 2021 budget, Canada allocated additional funds for childcare, making it more affordable at $10/day, an unprecedented leap for Canada (McLaren, 2021). In 2016, the country dedicated $8.4 billion to addressing SDH of its’ Indigenous people, a long overdue commitment. Canada is working to increase the quality and access to improved SDH by engaging providers to participate in strategies, such as outreach to hard to reach patients or those who have been lost to follow-up; also integrating new positions like the Nurse Navigator who can follow the patient in the community working to help eliminate the barriers by offering resources and programs (Anderman, 2016).

	outcomes. President Joe Biden has submitted a $1.5 trillion budget to Congress for approval; $3.9 billion has been requested to address several factors of the social determinates of health. Including, housing, mental health, health equity, civil rights, and reducing the maternal death rate (Vaida, 2021).
How has the	According to a report submitted by the World Health	When the WHO Director-General identified a collective
identified health	Organization, the Director-General states that there	failure to address social determinates and the
policy impacted the	has been a collective failure, globally, when tackling	fundamental causes of health inequity, Canada was
health of the global	social determinates and underlying causes of	not excluded from the report. Canada is struggling to
population? (Be	inequities. This has resulted in many low-income	improve the health equity of its poorer population, it
specific and provide	people already negatively impacted by SDH, to have	recognizes middle income to wealthy live healthier,
examples)	sustained and continued low quality housing, food	longer, happier lives (Government of Canada, 2020).
	insecurity, poor employment options, and poor	Implementing and sustaining programs and resources
	access to health services (WHO, 2021). This is most	have proven to more difficult than originally thought.
	evident by the state of poor people as we are in the
	midst of the Covid-19 pandemic.
Describe the	Nurses have a unique and intimate role in	Canadian nurses are held to an ethical and
potential impact of	supporting SDH. The nurse can use a social	professional standard when addressing SDH. The
the identified health	determinate of health assessment to identify the	Canadian Nurses Association released a position
policy on the role of	social factors that impact patients’ lives. By asking	statement expressing they believe all facets of nursing
nurse in each	about patients’ access to: healthy foods, clean	should strive to reduce and ultimately eliminate health
country.	drinking water, physical and mental health care,	inequality. Nurses should include SDH in their health
	safe, affordable housing, quality education and	assessments and interventions for patients (CNA,
	employment opportunities, safe and reliable	2018).
	transportation, and social support. Nurses are also
	able to collaborate with community, local, and state
	programs to address these deficits. Nurses can
	advocate for patients as healthcare workers and
	community citizens (Cirigliano, 2021). Nurses in role
	like Case Managers or Care Coordinators have
	expertise knowledge in assessing patients’ needs

	and identifying numerous resources in the community that can help to eliminate deficits patients face.
Explain how global health issues impact local healthcare organizations and policies in both countries. (Be specific and provide examples)	The health of the global community directly impacts the security and health of the United States. Early identification of global health threats help to mitigate its effects on the people living and traveling to the U.S. Infectious diseases like Ebola Virus, H1N1 Flu, and SARS Virus, all global health issues, effects were efficiently mitigated, preventing an international pandemic. Unfortunately for the United States, we did not mitigate the effects of Covid-19, thus the entire country has suffered as a result. Countless Americans became infected and have died from the Covid-19 virus; as of May 13, 2021, 584,500 people lost their lives to the Corona virus (JHU, 2021).	Canada is involved in several international initiatives to improve health worldwide. It offers its’ assistance to numerous countries helping to improve social factors. By collaborating with global organizations and its’ own Canadian civil society, Canada helps to provide life- saving resources to prevent and treat illnesses like HIV/AIDS, tuberculosis, malaria, malnutrition, and pneumonia. Canada has national security efforts in place to prevent the spread of communicable diseases (Government of Canada, 2021). The Canadian government has mitigated the effects of the Covid-19 virus, with 24,869 deaths as reported on May 14, 2021 (Government of Canada, 2021 NURS 6050 Global Healthcare Comparison Matrix and Narrative Statement).
General Notes/Comments	Both countries have similar barriers to addressing social determinates of health. The United States is lacking a singular dedicated entity to tackle SDH. Many federal departments have a hand in the issue, funding has been provided, but it appears when the rubber meets the road, only a small fraction of resources are actually used to address the issues. In my research I found a plan to build 250 new homes for a Baltimore community impacted by SDH; this is a meager attempt to address the overwhelming housing crisis the city faces.	Overwhelming research affirms Canada as one of the healthiest countries in the world. I found this to be a macro-assessment of the country’s health status, when digging deeper, I noted Canada has relished in this accomplishment, even though statistics usually do not account for the social factors that impact health. Canada has a long way to go to meet WHO’s guidelines for improving and ultimately eliminating social determinates of health.

A Plan for Social Change

As a nurse leader, I am professionally and personally accountable for effecting positive change in the communities in which I live, work and serve. Social determinates of health is a global initiative that affects my local community; advocating for improving the SDH is necessary to improve the health and wellbeing of my community. Advocating for resources and programs that work to tackle social factors would be a top priority.

Using my expertise and knowledge base, I will partner with community agencies to influence local and state policy makers to develop legislation that targets and prioritizes the social determinates of health in my communities.

The social determinates of health directly and indirectly impacts me as the nurse leader. Caring for patients in Baltimore City, it is not uncommon to see poor communities, food deserts, cut-rates and sub shops on every corner, only to drive 5-8 minutes up the road to find magnificent homes, nestled in affluent neighborhoods, close to fresh organic food markets and restaurants, quality healthcare centers, and low crime rates. Working within these different “pockets”, as we Baltimoreans call them, the impact on the nurse leader is palpable and unforgiving; I cannot, in good faith, address the health of my patients without first addressing the social factors that negatively impact their health.

Addressing the social determinates of health as nurse leader is indeed contributing to social change in my community and globally. Social change involves the advancement and improvement of individuals, communities, and the population, with a special focus on people in the community effected by systemic policies designed to keep them from achieving optimal health and wellbeing. One way to contribute to social change is to work toward eliminating inequities in access to quality healthcare, discrimination, employment, education, nutrition, housing, and other social determinates of health.